Acute GI Bleeding Flashcards

1
Q

What is upper GI bleeding?

A

Proximal to ligament of Trietz
- Oesophagus
- Stomach
- Duodneum

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2
Q

What is the clinical presentation of upper GI bleeding?

A
  • Haematemesis
  • Melaena
  • Elevated urea
  • Dyspepsia, reflux, epigastric pain
  • NSAIDs use
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3
Q

What is haematemesis?

A

Vomiting of blood
May be red or look like coffee grounds

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4
Q

What is melaena?

A

Black motions often like tar, with a characteristic smell of altered blood.

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5
Q

What are the oesophageal causes of upper GI bleeding?

A
  • Oesophageal ulcer
  • Oesophagitis
  • Oesophageal varices
  • Mallory Weiss tear
  • Oesophageal malignancy
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6
Q

What are the stomach causes of upper GI bleeding?

A
  • Gastric ulcer
  • Gastritic
  • Gastric varices
  • Gastric malignancy
  • Dieulafoy
  • Angiodysplasia
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7
Q

What are the duodenal causes of upper GI bleeding?

A
  • Duodenal ulcer
  • Duodenitis
  • Angiodysplasia
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8
Q

What are the most common causes of upper GI bleeding?

A

Peptic ulcers
Gastritis
Oesophagitis
Erosive duodenitis
Varices
Portal hypertensive gastropathy
Malignancy
Mallory Weiss tear
Valvular deformation- angiodysplasia, dieulafoy

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9
Q

What are the risk factors for peptic ulcers?

A

H. pylori
NSAIDs
Aspirin
Alcohol excess
Systemic illness

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10
Q

What are varices?

A

Abnormally dilate collateral vessels

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11
Q

What varices are most common?

A

Oesophageal- 90%
Gastric- 8%
Rectal and splenic- rare

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12
Q

What is Mallory- Weiss tear?

A

Linear tear to GO junction
Follows period of retching/vomiting

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13
Q

What is angiodysplasia?

A

Vascular malformation anywhere along the GI tract
Frequent cause of chronic occult or overt occult bleeding

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14
Q

What is diuelafoy?

A

Submucosal arteriolar vessel eroding through mucosa in the gastric fundus

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15
Q

What is lower GI bleeding?

A

Distal to ligament of Trietz
- Jejunum
- Ileum
- Colon

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16
Q

What is the clinical presentation of lower GI bleeding?

A
  • Fresh blood/clots
  • Magenta stools
  • Normal urea
  • Typically painless
  • More common in advanced age
17
Q

What are the causes of lower GI bleeding?

A

Diverticular disease
Haemorrhoids
Vascular malformations
- Angiodysplasia
- Arteriovenous malformation (AVM)
Neoplasia
- Carcinoma
- Polyps
Ischaemic colitis
Radiation enteropathy/proctitis
IBD
- UC
- CD

18
Q

What is diverticular disease?

A

Protrusion of inner mucosal lining through the outer muscular layer forming a pouch

19
Q

What is haemorrhoids?

A

Enlarged vascular cushions around anal canal

20
Q

What is lower GI neoplasia?

A

Colonic polyps or carcinoma

21
Q

What is ischaemic colitis?

A

Disruption in blood supply to colon

22
Q

What is radiation proctitis?

A

History of radiotherapy:
- Cervical cancer
- Prostate cancer

23
Q

What are the small bowel causes of lower GI bleeding?

A
  • Meckel’s diverticulum
  • Small bowel angiodysplasia
  • Small bowel tumour/ GIST
  • Small bowel ulceration (NSAID associated)
  • Aortoentero fistulation (following AAA repair)
24
Q

What are the steps for management of acute GI bleeding?

A
  1. Resuscitation
  2. Risk stratification
  3. Diagnosis + treatment
    1. Upper GI: Endoscopy
    2. Lower GI: Colonoscopy or CT angiogram
  4. Withhold/reverse contributory medications
  5. Specific medications
    1. PPI
    2. Tranexamic acid
  6. Consider CT angiography/interventional radiography/ surgical interventions
25
What is the management for peptic ulcers?
Endoscopy PPIs Angiography with embolization Laparotomy
26
What is the management for varices?
Endoscopy Terlipressin Antibiotics Reverse abnormal coagulation Sengstaken blakemore tube Transjugular intrahepatic portosystemic chunts (TIPSS)